307例胰腺癌的外科治疗体会

Experiences in surgical management for 307 cases of pancreatic cancer

目的 探讨进一步提高胰腺癌外科治疗效果的措施。方法 回顾本研究所 1988年至1998年外科治疗 30 7例胰腺癌病人的临床资料 ,结合部分病人随访结果分析总结。结果 30 7例中手术切除 118例 ,姑息性手术 178例 ,单纯剖腹探查 11例。切除 118例中行胰头十二指肠切除 95例 ,胰体尾部切除 14例 ,全胰切除 9例。姑息性手术 178例中行单纯胆肠和 (或 )胃肠转流 5 2例 ,转流 +胰周动脉结扎 4 5例 ,转流 +区域灌注化疗 4 2例 ,转流 +胰周动脉结扎 +区域灌注化疗 39例。随访 2 0 1例 ,手术切除组行胰十二指肠切除、胰体尾部切除及全胰切除者的平均生存期分别为 (2 9 6± 6 2 )个月、(10 3± 2 1)个月、(8 1± 1 1)个月 ,姑息手术组的平均生存期为 (8 9± 2 6 )个月 ,单纯剖腹探查者均于 3个月内病故。胰十二指肠切除组中行扩大切除者的 1、3、5年生存率较经典切除者显著提高 ;姑息手术组中合并胰周动脉结扎和 (或 )区域性化疗者的生存期较单纯转流手术者明显延长。结论 提高根治切除率是改善胰腺癌病人预后的关键 ,根据肿瘤进展程度选择适当适应证 ,合理地扩大切除范围可提高和改进手术切除的疗效 ;对不能切除病灶的中晚期病人 ,胰周动脉结扎和区域灌注化疗具有缓解症状 ,延长生存期的疗效。

Objective To explore measures for improving the result of surgical treatment in pancreatic cancer. Methods Clinical data and followed up results of 307 cases of pancreatic cancer treated surgically in our institute between 1988 and 1998 were analysed retrospectively. Results Of the 307 patients,118 under surgical resection,178 subjectted to palliative procedures and 11 only laparotomy.In the resected group,pancreatoduodenecotomy, distal pancreatectomy and total pancreatectomy was performed on 95,14 and 9 patients respectively.While in the palliatived group,52 cases were treated with simple bilo/gastro enterostomy,45 cases bilo/gastro enterostomy combined with peripancreatic arterial occlusion,42 cases bilo /gastro enterostomy combined with regional chemotherapy,39 cases bilo/gastro -enterostomy combined with peripancreatic arterial occlusion and regional chemotherapy.In 201 followed up patients,the mean survival time was (29 6±6 2) month in pancreatoduodenecotomy cases, (10 3±2 1) month in distal pancreatectomy cases and (8 1±1 1) month in total pancreatectomy cases,while it was (8 9±2 6) month in palliatived group. In patients undergoing only lapatotomy,none survived more than 3 months.The 1,3,5 year survial rate in extended pancreatoduodenecotomy group were significantly higher than those of the standard pancreatoduodenecotomy group.In palliatived group,the survival time of patients treated with bilo/gastro enterostomy combined with peripancreatic arterial occlusion and regional chemotherapy was significantly longer than that of the patients treated with simple bilo/gastro enterostomy. Conclusions Higher radical resection rate is pivotal for improving the prognosis of patients with pancreatic cancer.Rational extended resection based on the stage of tumor can ameliorate the result of surgical resection. In unresectable patients, peripancreatic arterial occlusion and regional chemotherapy can exert effects of relieving symptoms and prolonging survival time.